How to Choose a Medicare Plan That Fits You

Choosing a Medicare plan doesn’t have to be overwhelming. If you’re turning 65 or becoming eligible due to a disability, you've probably seen a lot of confusing information. Taking a few steps can help you find a plan that fits your health needs, budget, and lifestyle.

Here’s a breakdown to guide you through how to choose a Medicare plan that works for you.

MEDICARE BASICS

Medicare is health insurance from the federal government. Most people qualify at age 65, but you may also be eligible earlier due to disability or certain health conditions.

Here are the main types of Medicare plans:

• Part A (hospital insurance): Covers inpatient hospital care, skilled nursing, hospice, and some home healthcare. Most people don’t pay a premium for Part A if they worked long enough.
• Part B (medical insurance): Covers outpatient care, like doctor visits, lab tests, preventive services, mental healthcare, and durable medical equipment. You pay a monthly premium for Part B.
• Part C (Medicare Advantage): These plans from private insurers bundle Part A and Part B and often include extra benefits like dental, vision, and drug coverage (Part D).
• Part D (prescription drug coverage): Covers medication and is offered by private insurers.  You can add this coverage to Original Medicare, a Medicare Supplement plan, or to a Medicare Advantage plan (it is often included in MA plans).
• Medigap (supplement plans): Helps pay out-of-pocket costs not covered by Original Medicare, such as deductibles and copays. You cannot use Medigap with Medicare Advantage.

You can piece together what you need for your Medicare plan. The best combination depends on your personal health, your providers, and your budget.

STEP 1: REVIEW YOUR HEALTH AND PRESCRIPTION NEEDS

When figuring out how to choose a Medicare plan, start by looking at your current health.

Ask yourself:

• Do you have any chronic conditions or ongoing treatments?
• Do you take prescriptions regularly?
• Do you see certain doctors or want to use specific hospitals?
• Are those providers in-network for the plan you’re considering?
• How much will my medication cost on these plans?

Your answers will guide which Medicare plan offers the right coverage and access.

Plans with lower premiums might cost you more overall if they don’t cover your medications or your providers are out-of-network. Be sure to check the plan’s network and drug list (formulary).

STEP 2: COMPARE THE TYPES OF MEDICARE PLANS

There’s no one-size-fits-all Medicare plan. Here’s a quick breakdown to help you compare options:

If you want the flexibility to see any doctor and travel often, Original Medicare plus a Medigap plan may be a good choice. If you prefer all-in-one coverage, Medicare Advantage could be the right fit.

Original Medicare does not have a maximum out-of-pocket each year. When Medicare pays 80%, you pay 20% without a limit on how much you’ll spend. Medicare Advantage plans have a maximum out-of-pocket which can give you a better idea of what you can expect to pay each year.

STEP 3: UNDERSTAND MEDICARE PLAN COSTS

Medicare plan costs go beyond just the monthly premium. When comparing plans, look at:

• Monthly premium: What you pay each month
• Deductible: What you must pay before the plan begins covering care
• Copays and coinsurance: Your share of costs for services and medications
• Out-of-pocket maximum (Part C plans only): The most you’ll pay in a year for covered services

Each Medicare option comes with different costs both up front and over time.

Most Original Medicare subscribers will pay no premium for Part A. Part B coverage starts with a $185 monthly premium and may be higher depending on your income. Many people choose to deduct their Part B premium from their Social Security check.

Each of these two parts has its own deductible as well.

Part C premiums and deductibles depend on the plan and insurer.

Your financial situation and healthcare needs should guide you in picking a plan that works best for you.

STEP 4: KNOW WHEN TO ENROLL

Enrollment periods matter. For those who want to sign up for Original Medicare, Part A and/or Part B, you need to sign up when you’re close to 65 (if you’re not receiving Social Security or RRB benefits).

If you elect to not enroll in Part B or Part D, and do not have credible coverage, you may pay a late enrollment penalty for as long as you have Part B.

MEDICARE ADVANTAGE PLAN ENROLLMENT PERIODS

Here’s when you can sign up or make changes:

• Initial Enrollment Period (IEP): Starts 3 months before your 65th birthday and lasts for 7 months
• Annual Enrollment Period (AEP): October 15–December 7 each year (for switching or enrolling in Advantage or Part D plans)
• Open Enrollment Period (OEP): Jan 1 - March 31 each year. You can make only one switch during this period.
• Special Enrollment Period (SEP): You may qualify if you lose coverage, move, or face certain life changes

Even if you’re happy with your current plan, review it during AEP. Benefits and costs change every year.

MAKE A CONFIDENT CHOICE

Choosing a Medicare plan takes a little homework, but it’s worth it. The right plan gives you peace of mind and helps you get the care you need when you need it.

Here’s how to keep it simple:

• Understand what Medicare covers
• Know the types of Medicare plans
• Think through your health needs and budget
• Compare plans carefully — don’t just focus on the premium
• Enroll during the correct period

Use the official Medicare Plan Finder tool to compare plans and find one for you.